Pain practice : the official journal of World Institute of Pain
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Randomized Controlled Trial
Subcutaneous Injection of Diclofenac for the Treatment of Pain Following Minor Orthopedic Surgery (DIRECT study): A Randomized Trial.
Parenteral diclofenac is frequently used for analgesia following minor orthopedic interventions. Currently available diclofenac formulations are for intramuscular (IM) or intravenous injection. A new 1 mL volume formulation of diclofenac containing hydroxypropyl-β-cyclodextrin (HPβCD) allows both SC and IM administration. The objective of this open-label, randomized, parallel group, active-controlled study was to assess the safety and efficacy of 75 mg diclofenac HPβCD, administered SC or IM, compared with IM Voltaren® 75 mg in inpatients undergoing minor orthopedic surgeries with moderate-to-severe postoperative pain. ⋯ Overall, the study results indicate that safety and efficacy were similar irrespective of the diclofenac formulation used; thus, the new SC diclofenac HPβCD has an acceptable tolerability profile and may be considered a valid alternative to IM-delivered diclofenac formulations.
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Randomized Controlled Trial
Effects of Topical Diclofenac Plus Heparin (Dhep+H Plaster) on Somatic Pain Sensitivity in Healthy Subjects With a Latent Algogenic Condition of the Lower Limb.
To evaluate whether a diclofenac epolamine + heparin topical (plaster) is more effective than diclofenac plaster alone in reducing deep somatic hyperalgesia in subjects without spontaneous pain and whether the effect is linked to or independent of the anti-edematous action of heparin. ⋯ Topical diclofenac+heparin is significantly more effective than diclofenac alone in reducing muscle hyperalgesia in subjects without spontaneous pain, independently of the anti-edematous action of heparin. The results provide a rationale for the use of diclofenac+heparin also in algogenic conditions without evident signs of injury/edema/hematoma.
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Review Case Reports
Complete Coverage of Phantom Limb and Stump Pain with Constant Current SCS System: A Case Report and Review of the Literature.
Spinal cord stimulator (SCS) technology has advanced over the past several years. However, our literature review revealed a lack of well-documented cases of successful treatment of phantom limb pain with percutaneous revision of previously placed systems. ⋯ We present the case of a patient who suffered from debilitating bilateral lower extremity phantom limb pain despite having a SCS with a constant voltage system. We used fluoroscopy to successfully guide a percutaneous octapolar paddle lead to the right of the existing surgical paddle lead and a cylindrical quadrapolar lead in between. Finally, the older paddle lead was connected to an extension to make it compatible with the updated constant current system. The revised constant current SCS system provided bilateral coverage of the patient's pain, and at 1-year postoperative, the patient reported he had sustained coverage from his bilateral phantom limb pain. Our patient had complete coverage of his phantom limb pain after his previously placed SCS was changed from a constant voltage to a constant current system, and percutaneous leads were connected to his system. Adding percutaneous leads or switching generator types may benefit patients whose pain patterns have expanded since original SCS system placement. This case reports the complete coverage of phantom limb pain with a change from a constant voltage to a constant current SCS system and the addition of percutaneous leads to an existing SCS system.
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The aim of this study was to prospectively assess the prognostic value of initial pain intensity and its duration in advanced cancer patients. ⋯ High levels of pain intensity, often due to previous undertreatment, are predictive of more complex analgesic treatment. Opioid tolerance, as well as younger age, may also play a role.
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Pregabalin is a commonly used therapy currently recommended as first-line treatment for a number of neuropathic pain (NeP) conditions. Since licensure, a number of clinical trials of pregabalin in different NeP conditions have been completed from which additional data on safety and tolerability can be drawn. In this analysis, patient-level data from 31 randomized clinical trials of pregabalin in peripheral NeP sponsored by Pfizer were pooled and assessed for incidence of adverse events (AEs). ⋯ Pregabalin vs. placebo risk analysis identified 9 AEs with a risk difference, for which the lower limit of the 95% confidence interval (CI) was > 1%: dizziness (risk difference [95% CI]: (17.0 [15.4 to 18.6]), somnolence (10.8 [9.5 to 12.1]), peripheral edema (5.4 [4.3 to 6.4]), weight increase (4.7 [3.9 to 5.5]), dry mouth (2.9 [2.1 to 3.8]), constipation (2.3 [1.5 to 3.2]), blurred vision (2.2 [1.6 to 2.9]), balance disorder (2.0 [1.5 to 2.5]), and euphoric mood (1.6 [1.2 to 2.0]). The most common AEs, dizziness and somnolence, typically emerged within the first 1 to 2 weeks of treatment and resolved 1 to 2 weeks later, without resulting in cessation of treatment. The data from this review provide information, indicating which AEs may be expected in patients treated with pregabalin, and suggest that careful dose titration to the highest tolerable dose is the most appropriate approach in clinical practice.